Advanced Search

Orthopedic Coding Alert

Never Miscode Bankart Procedures Again - Thanks to CPT 2004

Published on Thu Jan 01, 2004

The new coding manual teaches coders how to boost reimbursement for this common arthroscopic procedure

The new edition of CPT finally lays an old dog to rest and instructs coders on the proper way to report arthroscopic Bankart procedures, resulting in fewer claim denials and additional reimbursement for those coders who heed CPT's advice.
 
CPT 2004 directs surgeons who perform Bankart procedures through the scope to report 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy).
 
Although the AMA once advised coders to use 29807 (Arthroscopy, shoulder, surgical; repair of SLAP lesion) for this procedure, a new parenthetical note following the open Bankart code (23455, Capsulorrhaphy, anterior; with labral repair [e.g., Bankart procedure]) directs coders to use 29806 for the arthroscopic version of this shoulder repair.
 
Because the RVUs for 29806 are higher than for 29807 (27.54 vs. 26.77), this new advice will allow orthopedic surgeons to collect more reimbursement for Bankart procedures than in the past.
  
"With this change to the parenthetical note, the AMA has finally put to rest one of the most talked-about coding dilemmas for orthopedic coders," says Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopaedic Associates in New Brunswick, N.J. "Directing coders to report 29807 for arthroscopic Bankart repair never sat right with me, as the descriptor associated with that code limits its use to repair of a superior labrum anterior posterior (SLAP) lesion. SLAP repair and Bankart repair are not one and the same."

CPT Adds New Spinal Surgery Section

CPT 2004 offers a new and much-needed subsection to the spinal surgery codes. The codes for lateral extracavitary approach technique will allow spine coders to forego the unlisted-procedure code and start getting specific.
 
CPT introduced two base codes and one add-on code:

  • 22532 - Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic
     
  • 22533 - ... lumbar
     
  • +22534 - ... thoracic or lumbar, each additional vertebral segment (list separately in addition to code for primary procedure).
     
    According to the AMA's CPT Changes 2004 - An Insider's View, CPT added these codes to describe "vertebral body resection and fusion procedures at a single thoracic and lumbar level of the spine."
     
    Although CPT previously contained arthrodesis codes for anterior, anterolateral, posterior, posterolateral and lateral transverse techniques, coders were stuck using the unlisted-procedure code (22899) for the lateral extracavitary technique that allows a lateral view of the vertebral body.
     
    Assuming that insurers will carry over CPT's prior arthrodesis coding guidelines to the three new codes, you can report 22532 and 22533 along with other procedures when necessary, as long as you append modifier -51 (Multiple procedures) to the arthrodesis code. Code 22534, on the other hand, is an add-on code, so you cannot append modifier -51 and should only report it in conjunction with another procedure.

    New Spinal Codes Make Debut

    The new CPT manual also introduced a new spinal code series that covers vertebral corpectomy for lateral extracavitary approaches:
     

  • 63101 - Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragment(s); thoracic, single segment

  • 63102 - ... lumbar, single segment

  • +63103 - ... thoracic or lumbar, each additional segment.

    These spinal codes will most likely follow the CPT rules for the anterior and anterolateral approaches, which means that if the orthopedist performs only one portion of the resection and another physician (such as a neurosurgeon) performs the other aspects of the procedure, the orthopedic surgeon should append modifier -62 (Two surgeons) to the corpectomy code.

    Bone Tumor Ablation Code Introduced

    Another exciting addition to the 2004 manual is the addition of a bone tumor ablation code. "I can't tell you how excited I am about the new code," says Amy Fritz, CPC, coder at University Medical Billing in Salt Lake City. "One of our physicians performs radiofrequency ablations on a regular basis, and handles a lot of unusual cases on children with malignant tumors. We have been billing the unlisted-procedure code and having a fight to get it paid almost every time. I believe having an actual code will increase our reimbursement tremendously."
     
    Now, instead of reporting the unlisted-procedure code, you should report 20982 (Ablation, bone tumor[s] [e.g., osteoid osteoma, metatasis] radiofrequency, percutaneous, including computed tomographic guidance) when your orthopedist treats bone tumors.

    CPT Updates TPI Descriptor

    CPT 2004 made changes to 20552 to clarify the existing policy of reporting the trigger point injection code only once if you inject the same muscle multiple times. "If your providers routinely perform trigger point injections and you have current coding resources available, you shouldn't be as confused about reporting TPIs," says Debbie Gulledge, CPC, a coder in Charlotte, N.C. "You just need to pay close attention to the number of muscle groups involved."
     
    Adjust your superbill to include these changes the AMA made to the trigger point injection code descriptors:

  • 20550 - Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia")
     
  • 20551 - ... single tendon origin/insertion
     
  • 20552 - Injection(s); single or multiple trigger point(s), one or two muscle(s).

    "Aponeurosis," a term added to the descriptor for 20550, is a sheet-like fibrous membrane that resembles a flattened tendon and binds muscles together or connects muscle to bone. Many coders had problems determining whether to use 20550 or 20551 for injections to these sites, so revising 20550 should help clarify their use. Coders will also notice that 20550 and many other procedures no longer bear their starred procedure designation (*). See the article "CPT Clears Up Cloudy Starred Procedures" on page 5 for more information.
     
    The descriptor change to 20551 suggests that you can bill multiple units of 20551 if the physician injects separate tendon origins or insertions. These changes will clarify correct coding for multiple injections in the same muscle, as well as for multiple injections in different muscles. You should still report one unit of 20552 when performing one or more injections in one or two muscles.
     
    For one or more injections in three or more muscles, report one unit of 20553 (Injection[s]; single or multiple trigger point[s], three or more muscles). You should never bill multiple units of either code, even if you perform multiple injections or inject multiple muscles.

    CPT Adds Nerve Block Codes  

    CPT also added two new nerve block codes:
     

  • 64449 - Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration
     
  • 64517 - Injection, anesthetic agent; superior hypogastric plexus.

    In addition, CPT adds a new hyoid myotomy code (21685, Hyoid myotomy and suspension). This code will help surgeons who surgically fix the hyoid bone to address hypopharyngeal and base-of-tongue obstructions, which can cause sleep apnea.
     
    Orthopedic coders might notice new instructions at the beginning of CPT's musculoskeletal system code list, which state, "For computer-assisted musculoskeletal surgical navigational orthopedic procedures, report 0054T-0056T." The new codes are as follows:
     

  • +0054T - Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image guidance based on fluoroscopic images (list separately in addition to code for primary procedure)
     
  • +0055T - Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image guidance based on CT and MRI images (liseparately in addition to code for primary procedure)
     
  • +0056T - Computer-assisted musculoskeletal surgical navigational orthopedic procedure, imageless (list separately in addition to code for primary procedure).

    "The technology is in its early stages," Stout says, "but surgeons are very excited about its potential. Right now it's being used for total hip replacement, total knee replacement, and trauma surgery."
     
    Although CPT considers the Category III codes "temporary," you should always report these when available instead of unlisted-procedure codes. Not only is it correct coding but it allows the AMA to determine whether the code usage is frequent enough to warrant a permanent CPT Category I code.
     
    Note: Although this article presents the codes and editorial changes that orthopedic practices will use most often, you should review CPT 2004 in its entirety to ensure that you update your superbills in 2004 to reflect new, deleted and revised CPT codes.

    • Other Articles in this issue of

    Orthopedic Coding Alert

    View All